Is psychological flexibility a mediator between perceived stress and general anxiety or depression among suspected patients of the 2019 coronavirus disease (COVID-19)?

This study is aimed to investigate the status of general anxiety and depression among suspected patients of COVID-19 and explore whether psychological flexibility can serve as a mediator between perceived stress and general anxiety or depression. Total of 180 participants completed the online questionnaire which comprised demographic information, the Perceived Stress Scale (PSS), the 7-item Generalized Anxiety Disorder scale (GAD-7), the 9-item Patients Health Questionnaire (PHQ-9), the Acceptance and Action Questionnaire-II (AAQ-II) and the Cognitive Fusion Questionnaire (CFQ). Statistical methods including correlation analysis, multiple linear regression analysis and structural equation model were used in this study. The scores of 23.9% (43/180) and 34.4% (62/180) of participants were higher than the cut points of GAD-7 and PHQ-9 respectively. Psychological flexibility was significantly correlated with perceived stress, general anxiety and depression. Multiple regression analyses showed the possible mediation effect of psychological flexibility between perceived stress and general anxiety or depression. The structural equation model confirmed that psychological flexibility partially mediated between perceived stress and general anxiety or depression. Our findings suggested the potential benefit of Acceptance and Commitment Therapy (ACT) as a psychological support approach in suspected patients of COVID-19 because ACT targets psychological flexibility.

Stigma and its influencing factors among women with termination of pregnancy for fetal anomaly: A cross-sectional study.

OBJECTIVE: To investigate the level of stigma and identify its influencing factors among women with termination of pregnancy for fetal anomaly(TOPFA) in China. DESIGN: This was a cross-sectional study design. SETTING AND PARTICIPANTS: A total of 469 women with TOPFA were recruited from a tertiary care hospital in China using a convenience sampling method. MEASUREMENT AND FINDINGS: Women with TOPFA participating in the study completed the Demographic Characteristics Questionnaire, Individual Level Abortion Stigma Scale(ILASS), Acceptance and Action Questionnaire- II scale(AQQ- II), Cognitive Fusion Questionnaire scale (CFQ), Multidimensional Perceived Social Support Scale(MPSS), Responses to Stress Questionnaire (RSQ). Women with TOPFA reported moderate levels of stigma(1.49±0.60). Multiple linear regression showed that correlates influencing their stigma included gestational age (ß =0.103, P < 0.05), psychological flexibility (ß =-0.319, P < 0.01), social support(ß =-0.190, P < 0.01), and disengagement coping(ß =0.148, P < 0.05). KEY CONCLUSION AND IMPLICATION FOR PRACTICE: Gestational age and disengagement coping are positive predictors of stigma, but psychological flexibility and social support are negative predictors of stigma. Further attention should focus on developing targeted intervention strategies to improve protective and reduce harmful factors to confront the stigma-related challenges faced by women with TOPFA.

Levels and Determinants of Antenatal Breastfeeding Attitudes among Pregnant Women: A Cross-Sectional Study.

Breastfeeding attitudes are strong predictors of breastfeeding behavior. Gaining a deeper understanding on the levels and determinants of antenatal breastfeeding attitudes is crucial. This cross-sectional study involved 124 pregnant women at a tertiary hospital in Hunan, China. A self-administered questionnaire, the Iowa Infant Feeding Attitude Scale, the Edinburgh Postnatal Depression Scale, the Pregnancy Stress Rating Scale, the Childbirth Attitude Questionnaire, the Perceived Social Support Scale, and the Breastfeeding Knowledge Questionnaire were assessed during their first-trimester, second-trimester, and third-trimester hospital visit. Multiple linear regression was conducted to identify the determinants of breastfeeding attitudes. The participants reported neutral (56.39 ± 5.69) levels of breastfeeding attitudes. The determinants of antenatal breastfeeding attitudes were other family members' support for exclusive breastfeeding: moderate (ß = 0.278, p < 0.05), depressive symptoms (ß = -0.191, p < 0.05), and breastfeeding knowledge (ß = 0.434, p < 0.001). The variables explained 33.9% (adjusted R2) of the total variation in breastfeeding attitudes scores (F = 4.507, p < 0.001). Namely, other family members' support for EBF was a negative influence on positive breastfeeding attitudes. The women whose other family members were moderate of EBF had more positive attitudes toward breastfeeding compared to those whose other family members were very supportive of EBF. The depressive symptoms were negatively associated with positive breastfeeding attitudes, and lower levels of depressive symptoms were associated with higher levels of positive breastfeeding attitudes among pregnant women. Additionally, breastfeeding knowledge was positively associated with positive breastfeeding attitudes. The more knowledgeable about breastfeeding, the more positive the attitude towards breastfeeding. Health professionals should identify these modifiable factors that may contribute to poorer breastfeeding attitudes, which is useful in targeting promotions of breastfeeding.

Efficacy of psychosocial interventions for psychological distress among women undergoing termination of pregnancy for fetal anomaly: a systematic review.

BACKGROUND: Accumulating evidence shows that women experience serious psychological distress after terminating their pregnancy for fetal anomaly (TOPFA). Although the number of studies on psychosocial interventions (PSIs) for TOPFA women has increased, access to evidence-based support for medical staff who provide care to TOPFA women remains limited. A systematic review was conducted to provide an overview of available PSIs. METHODS: Nine major electronic databases in available in English and Chinese languages were searched to identify articles published from the databases' inception to November 2021. Our participants were TOPFA women; interventions were PSIs; the comparison was no limits; outcomes were psychological distress including depression, anxiety, and post-traumatic stress (PTSD); and study designs were experimental studies including randomized controlled trials (RCTs) and quasi-experimental studies. The Joanna Briggs Institute Critical Appraisal Checklist for RCTs and quasi-experimental studies was used to assess the quality of evidence. Subsequently, synthesis without meta-analysis of the findings was completed. RESULTS: A total of 1,730 studies were identified from the initial database, 37 of which were included in this research. The interventions tested included cognitive therapy, mindfulness, sandplay therapy, psychological counseling, family support, peer support, empathy nursing, bereavement care, solution-focused psychological nursing, and staged psychological nursing. Four of these studies were RCTs. Most interventions were implemented in hospitals in China by nurses. However, few studies reported details on implementation procedures, and the studies presented substantial heterogeneity. Most of the included studies were judged to be of high risk of bias. DISCUSSION: Although this review was limited by search strategies and most of the included studies were of low quality, it still provided some tentative support for PSIs for the treatment of TOPFA women. Further research is warranted to investigate the effects of specific components on TOPFA women by using randomized controlled designs and reporting intervention manuals based on psychotherapeutic theory.